Method and apparatus for treating an orthodontic patient

ABSTRACT

A method and apparatus for treating an orthodontic patient include processing that begins by generating digital information regarding the orthodontic patient by a site orthodontic system. The site orthodontic system then transmits the digital information to an orthodontic server, which creates an electronic patient record therefrom. The orthodontic server then generates an initial treatment from the electronic patient record, wherein the initial treatment plan includes precise steps to obtain a desired orthodontic structure. The orthodontic server then transmits a digital version of the initial treatment plan to the site orthodontic system. Upon confirmation from the site orthodontic system, the orthodontic server designs an orthodontic apparatus for one of the precise steps based on the treatment plan. The orthodontic apparatus is then fabricated and provided to the site orthodontic system. At predetermined points in time after installation of the orthodontic apparatus in accordance with the treatment plan, the patient&#39;s mouth is electronically scanned to obtain updated digital information. The site orthodontic system provides the updated digital information to the orthodontic server, which uses the updated digital information to update the electronic patient record. From the updated electronic patient record, the orthodontic server determines whether the actual movement of the patient&#39;s teeth is as predicted. If so, the next step of the initial treatment plan is executed. If, however, the actual movement is not as predicted, the orthodontic server adjusts the treatment plan to obtain the desired results. After the treatment plan has been adjusted, the next step of the revised treatment plan is executed. This monitoring of a patient&#39;s progress and revising the treatment plan, when necessary, continues throughout the treatment.

TECHNICAL FIELD OF THE INVENTION

This invention relates generally to the practice of orthodontics and inparticular to a method and apparatus for treating an orthodonticpatient.

BACKGROUND OF THE INVENTION

Orthodontics is the practice of manipulating a patient's teeth toprovide better function and appearance. In general, brackets are bondedto a patient's teeth and coupled together with an arched wire. Thecombination of the brackets and wire provide a force on the teethcausing them to move. Once the teeth have moved to a desired locationand are held in a place for a certain period of time, the body adaptsbone and tissue to maintain the teeth in the desired location. Tofurther assist in retaining the teeth in the desired location, a patientmay be fitted with a retainer.

To achieve tooth movement, orthodontists utilize their expertise tofirst determine a three-dimensional mental image of the patient'sphysical orthodontic structure and a three-dimensional mental image of adesired physical orthodontic structure for the patient, which may beassisted through the use of x-rays and/or models. Based on these mentalimages, the orthodontist further relies on his/her expertise to placethe brackets and/or bands on the teeth and to manually bend (i.e.,shape) wire, such that a force is asserted on the teeth to repositionthe teeth into the desired physical orthodontic structure. As the teethmove towards the desired location, the orthodontist makes continualjudgments as to the progress of the treatment, the next step in thetreatment (e.g., new bend in the wire, reposition or replace brackets,is head gear required, etc.), and the success of the previous step.

In general, the orthodontist makes manual adjustments to the wire and/orreplaces or repositions brackets based on his or her expert opinion.Unfortunately, in the oral environment, it is impossible for a humanbeing to accurately develop a visual three-dimensional image of anorthodontic structure due to the limitations of human sight and thephysical structure of a human mouth. In addition, it is humanlyimpossible to accurately estimate three-dimensional wire bends (with anaccuracy within a few degrees) and to manually apply such bends to awire. Further, it is humanly impossible to determine an ideal bracketlocation to achieve the desired orthodontic structure based on themental images. It is also extremely difficult to manually place bracketsin what is estimated to be the ideal location. Accordingly, orthodontictreatment is an iterative process requiring multiple wire changes, withthe process success and speed being very much dependent on theorthodontist's motor skills and diagnostic expertise. As a result ofmultiple wire changes, patient discomfort is increased as well as thecost. As one would expect, the quality of care varies greatly fromorthodontist to orthodontist as does the time to treat a patient.

As described, the practice of orthodontics is very much an art, relyingon the expert opinions and judgments of the orthodontist. In an effortto shift the practice of orthodontics from an art to a science, manyinnovations have been developed. For example, U.S. Pat. No. 5,518,397issued to Andreiko, et. al. provides a method of forming an orthodonticbrace. Such a method includes obtaining a model of the teeth of apatient's mouth and a prescription of desired positioning of such teeth.The contour of the teeth of the patient's mouth is determined, from themodel. Calculations of the contour and the desired positioning of thepatient's teeth are then made to determine the geometry (e.g., groovesor slots) to be provided. Custom brackets including a special geometryare then created for receiving an arch wire to form an orthodontic bracesystem. Such geometry is intended to provide for the disposition of thearched wire on the bracket in a progressive curvature in a horizontalplane and a substantially linear configuration in a vertical plane. Thegeometry of the brackets is altered, (e.g., by cutting grooves into thebrackets at individual positions and angles and with particular depth)in accordance with such calculations of the bracket geometry. In such asystem, the brackets are customized to provide three-dimensionalmovement of the teeth, once the wire, which has a two dimensional shape(i.e., linear shape in the vertical plane and curvature in thehorizontal plane), is applied to the brackets.

Other innovations relating to bracket and bracket placements have alsobeen patented. For example, such patent innovations are disclosed inU.S. Pat. No. 5,618,716 entitled “Orthodontic Bracket and Ligature” amethod of ligating arch wires to brackets, U.S. Pat. No. 5,011,405“Entitled Method for Determining Orthodontic Bracket Placement,” U.S.Pat. No. 5,395,238 entitled “Method of Forming Orthodontic Brace,” andU.S. Pat. No. 5,533,895 entitled “Orthodontic Appliance and GroupStandardize Brackets therefore and methods of making, assembling andusing appliance to straighten teeth”.

Unfortunately, the current innovations to change the practice oforthodontics from an art to a science have only made limited progress.This limit is due to, but not restricted to, the brackets being thefocal point for orthodontic manipulation. By having the brackets as thefocal point, placement of each bracket on a corresponding tooth iscritical. Since each bracket includes a custom sized and positioned wireretaining groove, a misplacement of a bracket by a small amount (e.g.,an error vector having a magnitude of millimeter or less and an angle ofa few degrees or less) can cause a different force system (i.e.,magnitude of movement and direction of movement) than the desired forcesystem to be applied to the tooth. As such, the toot will not berepositioned to the desired location.

Another issue with the brackets being the focal point is that once thebrackets are placed on the teeth, they are generally fixed for theentire treatment. As such, if the treatment is not progressing asoriginally calculated, the orthodontist uses his or her expertise tomake the appropriate changes. The treatment may not progress asoriginally calculated for several reasons. For example, misplacement ofa bracket, misapplication of a bend in the wire, loss or attrition of abracket, bonding failure, the patient falls outside of the “normal”patient model (e.g., poor growth, anatomical constraints, etc.), patientlack of cooperation in use of auxiliary appliance, etc. are factors indelayed treatment results. When one of these conditions arise, theorthodontist utilizes his or her expertise to apply manual bends to thewire to “correct” the errors in treatment. Thus, after the originalscientific design of the brackets, the practice of orthodontics convertsback to an art for many patients for the remainder of the treatment.

Another issue with the brackets being the focal point is that customizedbrackets are expensive. A customized bracket is produced by milling apiece of metal (e.g., stainless steel, aluminum, ceramic, titanium,etc.) and tumble polishing the milled bracket. While the milling processis very accurate, some of the accuracy is lost by tumble polishing.Further accuracy is lost in that the placement of the brackets on theteeth and installation of the wire are imprecise operations. As isknown, a slight misplacement of one bracket changes the force onmultiple teeth and hinders treatment. To assist in the placement of thecustom brackets, they are usually shipped to the orthodontist in aninstallation jig. Such an installation jig is also expensive. Thus, suchscientific orthodontic treatment is expensive and has many inherentinaccuracies.

Therefore, a need exists for a method and apparatus that provides ascientific approach to orthodontic care throughout the treatment,minimizes the treatment cycle, decreases patient inconvenience anddiscomfort, and maintains treatment costs.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a schematic block diagram of an orthodontic system inaccordance with the present system;

FIG. 2 illustrates an alternate schematic block diagram of anorthodontic system in accordance with the present invention;

FIG. 3 illustrates a graphical representation of an orthodonticapparatus being applied to a patient's teeth in accordance with thepresent invention;

FIG. 4 illustrates an isometric view of a bracket having a generic wireretention receptacle in accordance with the present invention;

FIG. 5 illustrates an isometric view of a bracket including a specificwire retention receptacle in accordance with the present invention;

FIG. 6 illustrates a graphical representation of recalculating bends ofa wire due to misplacement of brackets in accordance with the presentinvention;

FIG. 7 illustrates a graphical representation of a bracket bonded to atooth in accordance with the present invention;

FIG. 8 illustrates a top view of a patient's mouth wherein the wireprovides movement in an XZ plane in accordance with the presentinvention;

FIG. 9 illustrates a graphical diagram of the wire providing movement ofthe teeth in the X and Y direction in accordance with the presentinvention;

FIG. 10 illustrates a logic diagram of a method for designing a seriesof wires in accordance with the present invention;

FIG. 11 illustrates a logic diagram of a method for designing anorthodontic apparatus in accordance with the present invention;

FIGS. 12 through 14 illustrate a logic diagram of a method for treatingan orthodontic patient in accordance with the present invention;

FIG. 15 illustrates a logic diagram of a method for monitoring apatient's progress in accordance with the present invention; and

FIG. 16 illustrates a logic diagram of an alternate method formonitoring a patient's progress during treatment in accordance with thepresent invention.

DETAILED DESCRIPTION OF A PREFERRED EMBODIMENT

Generally, the present invention provides a method and apparatus fortreating an orthodontic patient. Such a method and apparatus includeprocessing that begins by generating digital information regarding theorthodontic patient by a site orthodontic system. The digitalinformation may include a three-dimensional scan image of the patient'sorthodontic structure (e.g., teeth, jaw bone, gums, and other facialfeatures), x-rays, clinical examination and measurements, dentalhistory, medical history, photographs, etc. The site orthodontic systemthen transmits the digital information to an orthodontic server. Theorthodontic server and/or the site orthodontic system creates anelectronic patient record from the digital information. The electronicpatient record includes, but is not limited to, clinical examinationinterpretations, radiology examination measurements, automatic andmanual cephalometric analysis, a created electronic cephalometrictracings, an electronic composite including an integration of thethree-dimensional images, radiographic data (e.g., x-rays, CAT scans,MRI scans), photographs, a generated electronic articulation module,measurements and analysis of electronic models, data quality assurancechecks, and/or supplemental data.

The orthodontic server then generates an initial treatment plan from theelectronic patient record, wherein the initial treatment plan includesprecise steps to obtain a desired orthodontic structure. In other words,the initial treatment plan includes a series of steps, wherein, for eachstep, a corresponding orthodontic apparatus will be designed to reshapethe patient's orthodontic structure into a desired structure for theprecise step. The orthodontic server then transmits a digital version ofthe initial treatment plan to the site orthodontic system. Uponconfirmation from the site orthodontic system, the orthodontic serverdesigns an orthodontic apparatus (e.g., brackets, bands, wires, headgear, rubber band placement, and/or a retainer) for one of the precisesteps based on the treatment plan. The orthodontic apparatus is thenfabricated/assembled and provided to the site orthodontic system. Inaddition, the orthodontic server may provide practitioner and/or patientinstructions for use, maintenance, and/or installation of theorthodontic apparatus.

Upon receipt of the orthodontic apparatus, the orthodontist verifiesreceipt of the orthodontic apparatus and subsequently installs it. Atpredetermined points in time after the installation in accordance withthe treatment plan, the patient's mouth is electronically scanned toobtain updated digital information. The site orthodontic system providesthe updated digital information to the orthodontic server, which usesthe updated digital information to update the electronic patient record.From the updated electronic patient record, the orthodontic serverdetermines whether the actual movement of the patient's teeth is aspredicted. Such a determination may be supplemented with input from apractitioner (e.g., a technician, dental assistant, orthodontist,specialist, consultant, etc.) at the site or at a remote site withrespect to the patient. If so, the next step of the initial treatmentplan is executed (e.g., the wire for the next step is fabricated,provided to the orthodontist, and installed). If, however, the actualmovement is not as predicted, the orthodontic server adjusts thetreatment plan to obtain the desired results. After the treatment planhas been adjusted, the next step of the revised treatment plan isexecuted. This monitoring of a patient's progress and revising thetreatment plan, when necessary, continues throughout the treatment.Thus, with such a method and apparatus, a scientific approach isprovided to orthodontic treatment throughout the treatment, maintainsthe treatment costs at reasonable levels, and provides a more consistentand reduced treatment time. In addition, the present method andapparatus allow orthodontic practitioners to have just-in-timeinventory, allows for treatment adjustments that would be required dueto changes in tooth position and/or jaw development, and further allowsfor changes in the orthodontic structure if the force system becomessub-optimal.

The present invention can be more fully described with methods describedin FIGS. 1 through 16. FIG. 1 illustrates an orthodontic system 10 thatincludes a site orthodontic system 12 and an orthodontic server 14 thatare operably coupled together via a communication network 16. The siteorthodontic system 12 includes a scanner (not shown) to scan the mouthand facial features of a patient 18. The site orthodontic system 12 alsoincludes a processing module 20 and memory 22. The processing module 20may be a single processing device or a plurality of processing devices.Such a processing device may be a microprocessor, microcomputer, digitalsignal processor, central processing unit of a computer or work station,digital circuitry, state machine, and/or any device that manipulatessignals (e.g., analog and/or digital) based on operational instructions.The memory 22 may be a single memory device or a plurality of memorydevices. Such a memory device may be a random access memory, read-onlymemory, floppy disk memory, hard drive memory, extended memory, magnetictape memory, zip drive memory and/or any device that stores digitalinformation. Note that when the processing module 20 implements one ormore of its functions, via a state machine or logic circuitry, thememory storing the corresponding operational instructions is embeddedwithin the circuitry comprising the state machine or logic circuitry.

The orthodontic server 14 includes a processing module 24 and memory 26.The processing module 24 may be a single processing device or aplurality of processing devices. Such a processing device may be amicroprocessor, microcontroller, digital signal processor,microcomputer, central processing unit of a personal computer or a workstation, logic circuitry, state machine and/or any other device thatmanipulates signals (analog and/or digital) based on operationalinstructions. The memory 26 may be a single memory device or a pluralityof memory devices. Such a memory device may be read-only memory, randomaccess memory, floppy disk memory, magnetic tape memory, hard drivememory, magnetic tape memory, and/or any device that stores digitalinformation. Note that when the processing module 24 implements one ormore of its functions, via a state machine or logic circuitry, thememory storing the corresponding operational instructions is imbeddedwithin the circuitry comprising the state machine or logic circuitry.

The orthodontic server 14 is operably coupled to a database 28 oforthodontic parameters. The orthodontic parameters include, but are notlimited to, age, gender, race, physical geometry of a patient's teeth,mouth structure, bone structure, type of malocclusion, ethnicity,function, etc. In general, the orthodontic parameters include any humancharacteristic related to orthodontics that effect tooth positioning,movement, function, stability, appearance, structure of the bones,teeth, gums, pathology, patient's knowledge, medical history, dentalhistory, etc. and mechanical characteristics of the orthodonticapparatus that may be stored in a database system to enhance predictionof a patient's orthodontic treatment. In other words, the orthodonticparameters include case histories of previously treated patients thatare used to determine normal expected treatments, mechanical aspects ofthe brackets, bands, and wire, mean deviation from normalizedtreatments, and other statistical information regarding the normalizedtreatment of an orthodontic patient. In addition, as the electronicpatient records are received for new patients, and as the treatment forsuch patients is updated, this information is added to the database 28.

The communication network 16 coupling the site orthodontic system 12 tothe orthodontic server 14 may be a local area network, wide areanetwork, the Internet, the public switching telephone network (PSIN), adirect connect wire, ATM network, and/or any other type of datatransport structure. Accordingly, the orthodontic system 10 may be aself-contained system when the communication network 16 is a directconnect wire. Such a self-contained system would reside at anorthodontist's office or treatment center (e.g., a center run bypractitioners). Alternatively, the orthodontic system 10 may include aplurality of site orthodontic systems 12 located in the same building,or office, such that an orthodontist, or group of orthodontists, mayhave multiple treatment rooms for simultaneous patient treatment. As afurther alternative, the orthodontic system 10 may include a pluralityof site orthodontic systems 12 that are located in different geographiclocations (e.g., different buildings, different offices, differenttowns, different states, or different countries) than the orthodonticserver 14. In such a distributed system, the communication network 16would be a wide area network, local area network, the Internet, and/orthe PSTN. Still further, a distributed system may include a plurality oforthodontic servers 14.

Regardless of the configuration of the orthodontic system 10, theoverall processing of a patient's orthodontic treatment is essentiallythe same. When it has been determined that a patient 18 is to receiveorthodontic treatment, which may occur after several consultations withan orthodontist (several orthodontists, specialists, or dentists), thepatient's orthodontic structure is scanned 30. The patient's orthodonticstructure includes the patient's teeth, facial tissue, gums, bonestructure, and any other physical feature that affects the patient'sorthodontic treatment or is influenced by orthodontic care. The scannedimage of the patient's orthodontic structure is provided to the siteorthodontic system 12. Note that, as an alternative to scanning thepatient directly, a model, impression, or a stereolithograph (SRD) modelmay be scanned at the orthodontic site or the site of the server.Further note that the patient information may be referenced by a code toprovide anonymity to the identity of the patient.

The site orthodontic system 12 converts the scanned image of thepatient's orthodontic structure into a digital model of the patient'smalocclusions 32. Such a conversion is done by receiving the scannedimage of the patient's orthodontic structure, x-rays of the patient'sorthodontic structure, photographs, and/or other patient information andgenerating the three-dimensional (3-D) digital model therefrom. Such aconversion process is described in co-pending patent application havinga Ser. No. 09/452,034, a title of “Method and Apparatus for Producing aThree-Dimensional Digital Model of an Orthodontic Patient”, a filingdate the same as the filing date as the present patent application, andis assigned to the same assignee as the present invention.Alternatively, the site orthodontic system 12 may pass the scanned data,the x-rays, and the other patient information to the orthodontic server14 and the orthodontic server 14 generates the 3-D digital model.

The site orthodontic system 12 then transports the digital model of thepatient's malocclusions 32 and an electronic patient record via thecommunication network 16 to the orthodontic server 14. The electronicpatient record is a compilation of patient specific information that isbeneficial in treating the patient and includes, but is not limited to,clinical examination interpretations, radiology examinationmeasurements, automatic and manual cephalometric analysis, a createdelectronic cephalometric tracings, an electronic composite including anintegration of the three-dimensional images, radiographic data (e.g.,x-rays, CAT scans, MRI scans), photographs, a generated electronicarticulation module, measurements and analysis of electronic models,data quality assurance checks, patient's demographic data, patient'schief complaint, disclaimer forms, insurance, medical history, dentalhistory, patient's progress notes, patient's billing schedule andtracking, patient educational information, and/or supplemental data.Based on this information, and/or practitioner inputs, orthodonticparameters of like cases are retrieved from the database 28, which isused by the orthodontic server 14 to generate an initial treatment plan34. The orthodontic treatment plan includes a plurality of precise stepsapplied in sequence to obtain a desired orthodontic structure.Generation of the initial treatment plan is described in co-pendingpatent applicant having a Ser. No. 09/452,033, entitled “Method andApparatus for Automated Generation of a Patient Treatment Plan”, havinga filing date the same as the filing date of the present patentapplication, and is assigned to the same assignee as the present patentapplication.

The orthodontic server 14 provides the initial treatment plan to thesite orthodontic system 12 via the communication network 16. If the siteorthodontic system 12 confirms the initial treatment plan 34 (e.g., theorthodontist provides inputs to the system 12 that the patient andorthodontist agree to the treatment plan), the orthodontic server 14designs an orthodontic apparatus 36. The designing of the orthodonticapparatus is described in co-pending patent application having a Ser.No. 09/451,564, entitled “Method and Apparatus for Designing anOrthodontic Apparatus to Provide Tooth Movement”, having a filing datethe same as the filing date of the present patent application, and isassigned to the same assignee as the present patent application. Theorthodontic apparatus 36 includes at least a wire, and/or a wire andbrackets, and may further include one or more of bands, bonding agentthickness, headgear, rubber bands, bracket placement information, aretaining device, functional appliances (e.g., Herbst appliance,expander, etc.) and other mechanical devices to provide tooth movement(active apparatus) and/or tooth anchoring (passive apparatus). Theorthodontic apparatus 36 is then fabricated/assembled and provided tothe orthodontists for installation on the patient 18.

After the orthodontic apparatus 36 has been installed in the patient fora given period of time (e.g., two to six weeks as prescribed in thetreatment plan), the patient's orthodontic structure is rescanned 38.The rescanned orthodontic structure is converted into a digital model ofthe patient's current stage of malocclusion 32 by the site orthodonticsystem 12. The site orthodontic system 12 then provides the revised, ora new, digital model of the patient's current stage of malocclusion 32to the orthodontic server 14. The orthodontic server 14 determineswhether the actual orthodontic structure of the patient corresponds tothe calculated or estimated orthodontic structure per the correspondingstep of the initial treatment plan. The estimated orthodontic structureis determined based on the initial treatment plan and the correspondingdesign of the apparatus structure. If the actual orthodontic structure(e.g., the current positioning of the teeth) substantially match theestimated orthodontic structure, the orthodontic server 14 causes thenext orthodontic apparatus 36 to be generated in accordance with thenext step of the initial treatment plan. For the purposes of thisdiscussion, a substantial match occurs when the three-dimensionalposition of the teeth in the actual orthodontic structure are less thanone millimeter different in any one of the X, Y and Z direction than theestimated placement (i.e., the calculated position for the correspondingstep of the initial treatment plan), when the function of the upper andlower arches are substantially as predicted, stability of the teeth issubstantially as desired, and/or the appearance is substantially asdesired for the give n step. Note that the orthodontic structure may bescanned immediately after placement of the brackets to verify correctbracket placement. Such verification will be discussed in greater detailwith reference to FIG. 13.

If the orthodontic server 14 determines that the actual orthodonticstructure does not match the estimated orthodontic structure, theorthodontic server 14 adjusts the treatment plan based on the actualorthodontic structure, related orthodontic parameters used to create theinitial treatment plan, inputs from a practitioner, any otherorthodontic parameters to accommodate the revised treatment plan, andthe desired orthodontic structure. Based on the revised treatment plan,the orthodontic server 14 designs the next orthodontic apparatus 36 tobe applied. The newly designed orthodontic apparatus 36 is provided tothe orthodontist for installation on the patient. This process continuesfor each installation of the orthodontic apparratus 36 on the patient'smouth until the treatment plan has been completed. Typically, theorthodontic apparatus 36 will include, for the initial orthodonticapparatus installation, bracket and a wire having bends to provide athree-dimensional displacement or stabilization of at least one tooth.For subsequent steps of the treatment plan, the orthodontic apparatusincludes a wire and may further include rubber band placement,head-gear, etc. As such, a closed loop system is provided to treat anorthodontic condition of a patient in a scientific manner throughout thetreatment. By utilizing wires to provide the three-dimensionaldisplacement of teeth, corrections throughout the treatment plan mayreadily be made to achieve the desired orthodontic structure. Inaddition, customized wires provide more rapid treatment due to optimalforces being applied to each tooth. As one of average skill in the artwill appreciate, the orthodontic apparatus is fabricated to provide theappropriate tooth displacement in accordance with the treatment plan. Assuch, a wire may provide one-dimensional tooth displacement,two-dimensional tooth displacement, three-dimensional tooth displacementor tooth stabilization in any one of the three planes of space.

Alternative uses of the orthodontic system 10 include, but are notlimited to, a one time use that generates all the wires needed fortreatment, use to assist in bracket placement, generate a single superelastic wire and one finishing wire, and/or a one time use forcomparative diagnostic. As one of average skill in the art willappreciate, the orthodontics system 10 may be used in a variety of waysto make the practice of orthodontics more of a science than an art. Inaddition, various levels of security may be used within the system 10,allowing certain users access to all information while restrictingaccess of others to a portion of the information.

FIG. 2 illustrates a schematic block diagram of an alternate orthodonticsystem 50. The orthodontic system 50 includes at least two sites, anorthodontist's office, or orthodontic treatment facility, 52 and amanufacturing center 54 (e.g., a laboratory). The system 50 may alsoinclude a remote site 56. The portion of the system 50 located at theorthodontist's office 52 includes site orthodontic system 12, a display62, and a scanning device 58. The orthodontic office 52 may also includeother site computers 76 that integrate the orthodontist's officecomputers into a single system. As such billings, records, inventory,etc. may be networked together within the site orthodontic system 50 toprovide a single system at the orthodontist's office 52. In addition,the system 50 may be networked with product manufacturers of theorthodontic apparatus materials.

The scanning device 58 provides a white light signal, laser, ultrasound, and/or infrared on to the patient's teeth 70 to obtain a scannedimage. Such scanning is done under the control of the site orthodonticsystem 60 via control signals. The scanning device 58 retrieves a staticor dynamic image of the patient's teeth, which is provided to the siteorthodontic system 12.

The site orthodontic system 12 includes an electronic patient section64, an image processing section 66, a controller section 68, and a userinterface section (not shown). Note that each of these separate sectionsmay be achieved via operational instructions stored in memory 22 andexecuted by the processing module 20. The electronic patient section 64contains the three-dimensional scanned images of the patient, x-rays,clinical exams and measurements, dental history, medical history,patient consent forms, photographs, template entries such as chiefcomplaints, etc., free form entries, and extra data. The imageprocessing module 66 receives the data of the patient's teeth andproduces therefrom the three-dimensional image. The digital informationis provided to the orthodontic server 14 via the communication network16. Note that controller 68 provides control signals to the scanningdevice 58 which cause the scanning device 58 to obtain the videoinformation, or scanned image, of the patient's teeth 70. Such videoinformation includes, but is not limited to, live video images, stillvideo images, and/or photographs.

The orthodontic server 14, the database 28 and a wire bending robot 82are located at the manufacturing center 54. The orthodontic server 14,upon receiving the information from the site orthodontic system 12generates an electronic patient record for this particular patient. Theelectronic patient record includes, but is not limited to, clinicalexamination and interpretations, radiological examination measurements,automatic and manual cephalometric analysis, created electroniccephalometric tracings, an electronic composite of the 3-D images, radiographic data, and photographs, generated electronic articulation models,measured and analyzed electronic modules, data quality assurance checksand/or supplemental data.

The orthodontic server 14 includes a simulator module 84, a web server86, and a diagnostic support module 88. The simulator module 84 utilizesthe electronic patient record and orthodontic parameters from thedatabase 28 to design the orthodontic apparatus. The design of the wireis then provided to the wire bending robot 82, which bends the wire ofthe orthodontic apparatus in three-dimensions such that the wireprovides three-dimensional displacement of the patient's teeth. If theorthodontic apparatus includes auxiliary appliances, the design for suchappliances is provided to a manufacturer for fabrication. By having thewire provide the three-dimensional displacements, the brackets appliedto the patient's teeth may be generic. As such, the orthodonticapparatus of the present invention is considerably less expensive thanthe customized brackets of previous orthodontic treatments, improves theaccuracy of orthodontic care, and reduces the criticality of bracketplacement. The wire bending robot 82 may be a bending robot such as onemanufactured by Orthotel, Inc.

The web server 86 provides a web page for patients to obtain patientinformation 92 and for practitioners to access practitioner information94. As such, the orthodontic server 14 may provide patients with a webpage for answers to frequently asked questions, chat groups, tips onmaintaining proper dental care during orthodontic treatment and/or anyinformation related to a patient's dental and/or orthodontic care needs.The orthodontic server 14 may also provide practitioner information 94to practitioners. Such information 94 may be located on a web page thatprovides practitioners with information related to the practice oforthodontics. In addition, the web page may provide information relatedto the particular patient being treated. Such information may beaccessed utilizing a password or some form of encryption key.

The orthodontic server 14 includes a diagnostic support module 88 thatactually generates the corresponding information that is provided to thesimulator 84. The diagnostic support module 88 may be coupled to adiagnostic computer 90 and support facility equipment 91. The diagnosticcomputer 90 may be operated by an orthodontist or professionalassociated with the manufacturing center 54 to coordinate the design andmaintenance of the orthodontic apparatus. In addition, the diagnosticcomputer provides an input for practitioners to provide the clinicalexamination information and other patient related data, The supportfacility 91 may include a personal computer, or work station, thattracks patient billing information, and/or supplemental patientinformation relating to the orthodontic treatment.

The system 50 may also include a remote diagnostic computer 78 locatedat the remote site 56. The remote diagnostic computer 78 allowsorthodontists and/or other practitioners not located at themanufacturing center 54 to provide input as to the orthodontic treatmentof a particular patient. In addition, the remote diagnostic computer 78may be operated by a specialist who has been consulted for a particularcase.

The initial treatment plan generated by the orthodontic server 14 mayinclude inputs from multi-faceted disciplines. For example, before theorthodontic treatment can begin a physician may need to be consulted forparticular medical reasons. For instance, a patient may requireparticular medications before each treatment to avoid complications ofcertain medical conditions. In addition, before orthodontic treatmentcan begin, tooth extraction may be required, thus consultation with adentist is needed. Further, a patient may require special treatment suchas jaw surgery, headgear, rubber bands, etc. If special treatment isneeded, the database 28 is accessed to determine whether there is a casematch. If so, the case history for the previous treatment is integratedinto the treatment plan for the present patient. If a case match was notfound, the orthodontic practitioner's at the manufacturing site 54 usingtheir expertise, the expertise of the care provider, consultants, etc.,and/or near match case histories, generate the initial treatment plan.

The wire-bending robot 82 generates the wires having three-dimensionalbends to provide three-dimensional displacement of the patient's teeth.Based on inputs of the orthodontic server, the wire-bending robotgenerates the corresponding wires for each step of the treatment plan.Note that a full series of wires may be generated at one time, or thewires can be generated one at a time in accordance with a correspondingstep of the treatment plan. By utilizing the wire bending robot 82precise bends, loops, and/or other force system manipulations in thewires may be obtained thereby eliminating the inaccuracies of human wirebending. In addition, three-dimensional bends may be achieved to providethree-dimensional displacement, or stabilization, of one or more teeth.As such, the displacement of teeth is primarily incorporated into thewires such that generic brackets may be used on the patient's teeththereby reducing the costs. In addition, by utilizing the close loopsystem as shown in FIG. 2, subsequent wires in the treatment plan may bemanipulated to give updated tooth displacement such that the desiredorthodontic structure is obtained within the prescribed treatment time.

FIG. 3 illustrates a graphical representation of a patient's teethhaving an orthodontic apparatus attached thereto. The orthodonticapparatus includes a plurality of brackets 102 and a wire 104. As shown,the brackets 102 and wire 104 are installed below the gum and bone line100. Throughout the treatment, the brackets are fixed to the teethwhereby the wire 104 is manipulated to achieve the desired orthodonticstructure (i.e., the desired tooth placement). The brackets 102 may bethe type of brackets found in FIG. 4 or FIG. 5.

FIG. 4 illustrates a standard bracket or a generic prescription bracket102 that includes a generic wire retention receptacle 106. For thestandard bracket, the generic wire retention receptacle 106 is a simplegroove (i.e., a slot) in the bracket 104 without complex angles ordepths. For the generic prescription bracket 102, the generic wireretention receptacle 106 is a groove in the bracket 104 that includes ageneric angularity. The wire 104 is inserted into the bracket as shownto provide the desired torque on the corresponding tooth.

FIG. 5 illustrates a custom bracket 102 having a specific wire retentionreceptacle 108. In this embodiment, the bracket has the retentionreceptacle 108 designed to include complex angles of depth and groovethat are determined for a particular patient. As such, the orthodonticapparatus applied to a patient's teeth may include brackets havinggeneric wire retention receptacles 106 or brackets having specific wireretention receptacles 108.

FIG. 6 illustrates a graphical representation of the actual placement ofbrackets and wire on the patient's teeth. The actual bracket placement102 is shown by the solid lines while the ideal bracket placement 112 isshown by the dashed lines. Correspondingly the adjusted wire design 110is shown in solid lines while the ideal wire design 116 is shown indashed lines. As previously mentioned, with current technologies thatutilize the bracket to provide the force system for tooth displacement,the location of the bracket on the tooth is critical. As such, a bracketmisplacement in prior art implementations causes non optimal toothmovement. With the present invention, the initial treatment plan may becreated from the digital model of the patient's teeth prior to theinstallation of the brackets. The treatment plan may then be revisedonce the brackets are installed. As such, in the example shown in FIG.6, when the actual bracket placement is not in the ideal bracketplacement 112 location, the treatment plan may be adjusted therebyyielding the adjusted wire design 110. As such, even though the bracketsare not in the initial ideal place, the treatment will still be ideal byredesigning the subsequent wires and/or a template, and/or instructions,on adjusting a present wire, to provide the desired displacement.

Note that, as the teeth move, the relative bracket position changesthereby causing the force system on the tooth to be different. Inaddition, each tooth surface is different, which, when a bracket isapplied in accordance with a generic placement prescription, willgenerate a different force system causing varying tooth movement. Thepresent invention allows for such conditions and compensates for suchconditions utilizing the closed loop feedback system previouslydiscussed. In addition, it is not uncommon for a patient to lose abracket. When this occurs, the orthodontist is required to replace thebracket, which may not be replaced in the ideal location either due tomisalignment by the practitioner or drift of the bracket. As such, oncea bracket has been replaced, a new scan may be performed to obtain a newdigital model such that corrected wire design may be performed.

FIG. 7 illustrates a tooth 122 having a bracket 102 bonded thereto. Thebracket is bonded using a bonding agent 120, which has a thickness 124.Based on the thickness 124 of the bonding agent 120, the force system onthe tooth may vary. As such, the present invention can incorporate thebonding agent thickness 124 into the treatment plan and compensate forvariations thereof. In addition, the present invention may prescribe aparticular bonding agent thickness 124 of varying angles and depths toachieve the desired tooth displacement. Still further, the base of thebracket may be angular in two or three-dimensions of space to providefurther displacement options.

FIGS. 8 and 9 illustrate the three-dimensional displacement achieved bythe wires fabricated in accordance with the present invention. In FIG.8, which depicts a top view of a patient's teeth, the treatment planindicates that one tooth is to have a Z direction movement 126 while asecond tooth has a desired X, Z plane movement 128. The wire 104 isfabricated to provide the desired X, Z plane movement 128 and thedesired Z direction movement 126. In addition, as shown in FIG. 9, thewire is fabricated to provide the desired X direction movement 132 ofthe first tooth and a desired Y direction movement 130 of the secondtooth. As such, by fabricating the wire in accordance to the presentinvention, three-dimensional displacement of the teeth 70 may beobtained.

FIG. 10 illustrates a logic diagram of a method performed by theorthodontic server 14 to assist in the treatment of an orthodonticpatient. The process begins at step 140 where a digital model of apatient's malocclusion is generated from a three-dimensional image ofthe patient's orthodontic structure and/or facial structure. Thethree-dimensional image may be generated by scanning the patient's mouthand facial area. The orthodontic structure includes the patient's teeth,gums, jawbone, and associated soft tissue while the facial structureincludes further facial bones and soft tissue. The process then proceedsto step 142 where an initial treatment plan is derived for the patientfrom the digital model and orthodontic parameters relating to thepatient. The initial treatment plan includes precise steps to obtain adesired orthodontic structure. The process then proceeds to step 144where a series of wires are designed to correspond with the precisesteps of the initial treatment plan. Each wire is designed to providethree-dimensional displacement of the patient's orthodontic structure,when threedimensional displacement is needed. In addition to designingthe wires, the brackets may be fabricated for each tooth wherein eachbracket includes a generic wire retention receptacle, a specific bondingthickness, a specific bracket base, and/or a specific wire retentionreceptacle.

Having fabricated the brackets, a wire is fabricated to providethree-dimensional displacement of the patient's orthodontic structure inaccordance with a particular precise step. As such, for each step of thetreatment plan, or revised treatment plan, a wire is fabricated toprovide three-dimensional displacement for brackets including a genericwire retention receptacle. Alternatively, at least one of the bracketsmay be fabricated with a specific wire retention receptacle that assistsin providing three-dimensional displacement of the patient's tooth inaccordance with the particular precise step. In addition, the bracketbonding thickness, or base, may be determined to further providethree-dimensional displacement of the patient's orthodontic structure(i.e., the patient's tooth or teeth). Further, band sizing and fittingmay be simulated as part of the orthodontic apparatus, which allows forelectronic selection of an appropriate band size or fabrication.

The process then proceeds to step 146 where after a wire has beenapplied, a subsequent digital model is generated to represent a currentactual orthodontic structure. The process then proceeds to step 148where a determination is made as to whether the actual orthodonticstructure substantially matches an estimated orthodontic structure. Theprocess then proceeds to step 150 where the process branches dependingon whether the determination at step 148 was a match. If the actualorthodontic structure did not match the estimated orthodontic structure(i.e., the calculated desired movement of the teeth), the processproceeds to step 152. At step 152, the initial treatment plan isadjusted for subsequent precise steps to obtain the desired orthodonticstructure. As such, a threedimensional configuration of a newcorresponding orthodontic apparatus (e.g., the wire) for one of thesubsequent precise steps is redefined. The process then proceeds to step158 where the next wire is applied. Note that an adjustment to thetreatment plan may simply be extended time to achieve the desiredplacement for a current step without changing a wire. Further note, thatthe next step may use the same wire, but add new bends to it. Stillfurther note that the database of orthodontic parameters is updated withthe digital models of abnormal treatment results of the patient tofurther enhance subsequent treatment. The process then reverts to step146.

If, at step 150 a match occurred, the process proceeds to step 154. Atstep 154 a determination is made as to whether the treatment iscomplete. If not, the process proceeds to step 158 following thecorresponding path. If, however, the treatment is complete the processproceeds to step 156 where a retaining apparatus is generated from adigital model of the adjusted patient's malocclusions.

FIG. 11 illustrates a logic diagram of an alternate method for theorthodontic server to assist in the treatment of an orthodontic patient.The process begins at step 140 where a digital model of a patient'smalocclusion is generated from a three-dimensional image of thepatient's orthodontic structure and facial structure. This may beachieved by scanning the patient's oral cavity to obtain the digitalmodel using a three-dimensional light scanner. The process then proceedsto step 142 where an initial treatment plan is determined for thepatient from the digital model and orthodontic parameters relating tothe patient. The initial treatment plan includes precise steps to obtaina desired orthodontic structure. The orthodontic parameters include, butare not limited to, age, gender, race, bone density, facial structure,tooth displacement, etc. Note that the digital model of the patient maybe obtained subsequent to placement of the brackets on the patient'steeth. Having done this, the initial treatment plan may be adjusted tocompensate for any manual misplacement of a bracket. Alternatively, theinitial treatment plan may not be generated until after the initialplacement of the brackets on the patient's teeth.

The process then proceeds to step 160 where a corresponding orthodonticapparatus is generated for a precise step of the initial treatment plan.The corresponding orthodontic apparatus may include a wire, bracket,headgear, rubber bands, and/or a retainer. The orthodontic apparatus mayinclude a series of wires that correspond to the precise steps, atemplate for producing a wire for a given precise step, and/or anadjustment template for a wire of a subsequent precise step. If atemplate is developed, the orthodontist may make on-site accurate wirebend adjustments.

The process then proceeds to step 162 where a subsequent digital modelis generated after the orthodontic apparatus has been applied to obtaina digital image of the actual orthodontic structure. Note that a newdigital model is obtained and recorded each time a precise step of theinitial treatment plan is performed. Similarly, if the treatment plan isaltered, digital models are obtained for the revised orthodonticstructure.

The process then proceeds to step 161 where a determination is made asto whether the actual orthodontic structure matches an estimatedorthodontic structure. The process then proceeds to step 163 whichroutes further processing based on whether a match occurs. If a matchdoes not occur, the process proceeds to step 165 where the initialtreatment plan is adjusted for subsequent precise steps of the treatmentplan to obtain the desired orthodontic structure. The process thenproceeds to step 164 where the next orthodontic structure is applied tothe patient's teeth. Having done this, the process repeats at step 162.

If the actual orthodontic structure substantially matches the estimatedorthodontic structure, the process proceeds to step 167. At step 167, adetermination is made as to whether the treatment is complete. If not,the process proceeds to step 164. If the treatment is complete, theprocess proceeds to step 156. At step 156, a retaining apparatus isgenerated from a digital model of the adjusted patient's malocclusion.

FIGS. 12 through 14 illustrate a logic diagram performed by theorthodontic system 10 and 50. The process begins at step 170 where asite orthodontic system generates digital information regarding anorthodontic patient. The digital information includes, but is notlimited to, a three-dimensional image of the orthodontic patient'sorthodontic structure, a two-dimensional image of theorthodontic'patient's orthodontic structure (e.g., x-rays and pictures)and patient data. Note that the three-dimensional image may be obtainedby scanning the patient's mouth to obtain video data thereof andconverting the video data into a three-dimensional image. The processthen proceeds to step 172 where the orthodontic site transmits thedigital information to an orthodontic server. The digital informationmay be transmitted via an Internet connection, a local area networkconnection, a wide-area network connection, an in-direct connection, adirect connection, and/or a modem connection. The process then proceedsto step 174 where the orthodontic server creates an electronic patientrecord from the digital information and is updated as furtherinformation is obtained. The electronic patient record includes, but isnot limited to, clinical examination interpretations, radiologyexamination and measurements, automatic and/or manual cephalometricanalysis, orthodontic history, mechanics plan, treatment objective,credit history, chronological data, task delegation, risk analysis,ordering information for orthodontic apparatus, electronic cephalometrictracings, integrated three-dimensional images and radiology andphotograph images into an electronic composite, electronic articulationmodels, measurements and analysis of the electronic models, data qualityassurance checks, and/or supplemental data.

The process then proceeds to step 176 where the orthodontic servergenerates an initial treatment plan for the electronic patient. Togenerate the initial treatment plan, the orthodontic server determineswhether a multi-disciplinary treatment is involved. In other words, doesthe patient require additional medical treatment beyond orthodonticcare. If so, a physician is consulted to obtain additional medicaltreatment information. The orthodontic server also determines whetherinterdisciplinary treatment is needed. As such, the orthodontic serverdetermines whether other dental work is required beyond orthodontictreatment. For example, does the patient require tooth extraction. Ifso, the interdisciplinary treatment is added to the initial treatmentplan. In addition, special treatment may be further required such asunique brackets, wiring, etc. If special treatment is required,orthodontic parameters are retrieved from a database wherein theorthodontic parameters are identified by cross matching at least some ofthe characteristics of the electronic patient record with orthodonticparameters of other electronic patient records. A first pass treatmentplan is then generated based on the orthodontic parameters in theelectronic patient record. The special treatment information is thenintegrated with the first pass treatment plan to produce the initialtreatment plan. If special treatment is not required, the first passplan is used as the initial treatment plan.

THe process then proceeds to step 178 where the orthodontic servertransmits the initial treatment plan to the site orthodontic system. Theprocess then proceeds to step 180 where a determination is made as towhether the site orthodontic system approved of the initial plan viainputs from a practitioner. If not, the process proceeds to step 182where digital information regarding the patient is updated withadditional patient data. The process then reverts to step 172.

If, however, the site orthodontic system approves of the initialtreatment plan, the process proceeds to step 184. At step 184 theorthodontic server designs an orthodontic apparatus for a first precisestep of the initial treatment plan. Note that the initial design ay beenhanced by the use of a remote diagnostic computer such that additionalexperts may be consulted to generate the treatment and/or orthodonticapparatus. The process then proceeds to step 186 where the orthodonticapparatus is fabricated for the first precise step. If indirect bondingis to be used, the orthodontic apparatus includes brackets, an activewire, a passive wire, specialty appliances and indirect bonding tray. Ifdirect bonding is to be used, the orthodontic apparatus includesbrackets, a first active wire, a passive wire, and specialty appliances.Note that the active wire includes the three-dimensional bends thatapply the three-dimensional displacement of the tooth and a passive wireprovides zero forces upon a given tooth. Further note that the wire mayinclude an active portion and a passive portion.

The process then proceeds to step 188 of FIG. 13. At step 188, the siteorthodontic system updates the digital information after placement ofthe brackets. The process then proceeds to step 190 where the siteorthodontic system provides the updated digital information to theorthodontic server. The process then proceeds to step 192 where adetermination is made as to whether placement of the brackets is withina given tolerance. If not, the process proceeds to step 194 where atleast one bracket is repositioned. Having repositioned the brackets, theprocess reverts to step 188. Note that the determination of whether thebrackets are within a given tolerance may be done in real time such thatthe repositioning of the brackets has minimal impact on the patient'scare and/or time of treatment.

If the placement of the brackets is within a given tolerance withrespect to an error vector, the process proceeds to step 196. At step196, a wire is fabricated to provide three-dimensional displacementusing the actual placement of the brackets in accordance with the firstprecise step. Note that the orthodontic apparatus includes brackets, awire, bands, auxiliary appliances, headgear, rubber band placementand/or a retaining structure. The process then proceeds to step 198where the wire is installed into the patient's mouth. The processproceeds to step 200 where the site orthodontic system scans thepatient's mouth to obtain an actual orthodontic structure. The processthen proceeds to step 202 where the site orthodontic system transmitsthe new digital information containing the actual orthodontic structureto the orthodontic server.

The process then proceeds to step 204 where the orthodontic serverdetermines whether the actual orthodontic structure matches an estimatedorthodontic structure corresponding to the precise step. The processthen proceeds to step 206 where a branch occurs depending on whether amatch occurs within step 204. If a match does not occur, the processproceeds to step where the treatment plan is adjusted for subsequentprecise steps. As such, the treatment plan is revised to correct for thenon-compliant tooth movement. The process then proceeds to step 210where the treatment of the patient proceeds to the next precise step inaccordance with the adjusted treatment plan. Having done this, theprocess reverts to step 196. Note that, even if a match occurred at step206, the practitioner may choose to make an adjustment to expeditetreatment. As such, step 208 would be used to achieve the expeditedtreatment.

If a match occurs between the actual orthodontic structure and theestimated orthodontic structure, the process proceeds to step 212 ofFIG. 14. At step 212 a determination is made as to whether the treatmentis complete. If so, the process proceeds to step 216 where theorthodontic server designs a retaining device using the electronicpatient record which has been updated throughout the treatment. Notethat the orthodontic server may design the retaining device at or nearthe completion of treatment. If the treatment is not complete, theprocess proceeds to step 214 where the treatment of the patient proceedsto the next step in accordance with the initial treatment plan. Uponproceeding to the next step, the process reverts to step 196 of FIG. 13.

FIG. 15 illustrates a logic diagram of a method for the site orthodonticsystem to support the treatment of an orthodontic patient. The processbegins at step 220 where digital information regarding an orthodonticpatient is generated. The digital information includes athree-dimensional image of the patient's orthodontic structure, atwo-dimensional image of the orthodontic patient's orthodontic structureand patient data. The process then proceeds to step 222 where thedigital information is transmitted to an orthodontic server. The processthen proceeds to step 224 where a digital version of the treatment planis received. Upon receiving the treatment plan, the site orthodonticsystem may transmit a confirmation acknowledgment to the orthodonticserver.

The process then proceeds to step 226 where the digital information isupdated after the placement of the brackets. If a bracket weremisplaced, the bracket would be repositioned and the digital informationwould be updated. The process then proceeds to step 228 where theupdated digital information is transmitted to the orthodontic server.The process then proceeds to step 230 where digital information isgenerated for each application of an orthodontic structure in accordancewith one of the precise steps. As the digital information is generated,it is transmitted to the orthodontic server. This continues until thetreatment is complete. In addition, updates of the patient treatment maybe provided to the patient, via a soft copy using email or a hard copy,to a care provider, and/or to any other practitioner associated with thetreatment of the patient. Such updates may correspond to the precisesteps of the treatment plan, scheduled visits of the patient, and/or anyother desired triggering event.

FIG. 16 illustrates a logic diagram of an alternate method for the siteorthodontic system to assist in the treatment of an orthodontic patient.The process begins at step 240 where the patient's mouth is scanned toobtain video data of the orthodontic patient structure. The process thenproceeds to step 242 where the video data is converted into athree-dimensional image. The process then proceeds to step 244 where thedigital information is transmitted to an orthodontic server where thedigital information includes a three-dimensional image. The process thenproceeds to step 246 where a digital version of the initial treatment isreceived.

The preceding discussion has presented a method and apparatus fortreating an orthodontic patient. By utilizing a closed-loop system inaccordance with the present invention, each step of the treatment may bemonitored and correspondingly adjusted, if needed, thereby providing amore cost efficient and effective orthodontic treatment. In addition, byutilizing wires to provide three-dimensional displacement of a tooth,expensive custom brackets are not required thereby further reducing thecost of, and improving the accuracy of, orthodontic treatment.Alternatively, the system may be used in an open loop manner to provideone-time diagnostic information, bracket placement verification, and/orgeneration of the orthodontic apparatus without monitoring. As one ofaverage skill in the art would appreciate, other embodiments may bederived from the teaching of the present invention without deviatingfrom the scope of the claims.

What is claimed is:
 1. A method for treating an orthodontic patient, themethod comprising the steps of: a) generating digital informationregarding the orthodontic patient by a site orthodontic system; b)transmitting the digital information from the site orthodontic system toan orthodontic server; c) creating, by the orthodontic server, anelectronic patient record from the digital information; d) generating,by the orthodontic server, an initial treatment plan from the electronicpatient record, wherein the initial treatment plan includes a pluralityof tooth movement steps to obtain a desired orthodontic structure; e)transmitting, by the orthodontic server, a digital version of theinitial treatment plan to the site orthodontic system; f) designing, bythe orthodontic server, an orthodontic apparatus for one of theplurality of tooth movement steps upon receipt of treatment planconfirmation from the site orthodontic system and g) fabricating theorthodontic apparatus.
 2. The method of claim 1, further comprising:updating the digital information by the site orthodontic system afterplacement of a portion of the orthodontic apparatus; providing by thesite orthodontic system, the updated digital information to theorthodontic server; determining, by the orthodontic server, whether theplacement of the portion of the orthodontic apparatus has been placedwithin a given tolerance; and fabricating a second portion of theorthodontic apparatus to provide passive or active three-dimensionaldisplacement in relation to the placement of the portion of theorthodontic structure in accordance with the one of the plurality oftooth movement steps when the placement of the portion of theorthodontic apparatus has been placed within the given tolerance.
 3. Themethod of claim 2, further comprising: further updating the digitalinformation after replacement of the orthodontic apparatus when theplacement of at least one of the portion of the orthodontic apparatusexceeds the given tolerance.
 4. The method of claim 1, wherein step (b)further comprises transmitting the digital information to theorthodontic server via at least one of: an internet connection, a localarea network connection, a wide area network connection, a directconnection, and a modem connection.
 5. The method of claim 1, whereinstep (d) further comprises: obtaining supplemental treatment informationwhen special treatment is required; obtaining orthodontic parameters forthe orthodontic patient from a database of orthodontic parameters,wherein the orthodontic parameters are identified by cross-matching atleast some characteristics of the electronic patient record withorthodontic parameters of other electronic patient records; generating afirst pass treatment plan based on the orthodontic parameters and theelectronic patient record; and integrating the special treatmentinformation with the first pass treatment plan to produce the initialtreatment plan.
 6. The method of claim 1, wherein step (d) furthercomprises: obtaining orthodontic parameters for the orthodontic patientfrom a database of orthodontic parameters, wherein the orthodonticparameters are identified by cross-matching at least somecharacteristics of the electronic patient record with orthodonticparameters of other electronic patient records; and generating theinitial treatment plan based on the orthodontic parameters and theelectronic patient record.
 7. A method for treating an orthodonticpatient, the method comprising: scanning the orthodontic patient's mouthto derive digital information indicative of an orthodontic structure;creating an initial treatment plan for the orthodontic patient;designing and fabricating an orthodontic apparatus responsive to theinitial treatment plan; determining whether an actual orthodonticstructure for the orthodontic apparatus substantially matches anestimated orthodontic structure, wherein the estimated orthodonticstructure is derived in accordance with at least one of the initialtreatment plan including a plurality of tooth movement steps, and arevised treatment plan; and when the actual orthodontic structure doesnot substantially match the estimated orthodontic structure, adjustingthe at least one of initial treatment plan, and the revised treatmentplan, to obtain the desired orthodontic structure.
 8. The method ofclaim 7, further comprising when the actual orthodontic structuresubstantially matches the estimated orthodontic structure, generating anext corresponding orthodontic structure for a next step of theplurality of tooth movement steps of the initial treatment plan.
 9. Themethod of claim 7, wherein the orthodontic apparatus further comprisesat least one of: brackets, bands, a wire, head gear, rubber bandplacement, auxiliary appliances, and a retaining structure.
 10. Themethod of claim 7, wherein the step of scanning the orthodonticpatient's mouth to derive digital information further comprisesgenerating the digital information to include a three-dimensional imageof the orthodontic patient's orthodontic structure, and wherein themethod further comprises the step of obtaining data indicative of theorthodontic patient.
 11. The method of claim 10, further comprising:scanning the orthodontic patient's mouth and obtaining video data of thepatient's orthodontic structure; and converting the video data into thethree-dimensional image.
 12. The method of claim 7, further comprising,for each application of a corresponding apparatus of the initialtreatment plan, generating a three-dimensional image of the orthodonticpatient's current orthodontic structure; and providing thethree-dimensional image to the orthodontic server.
 13. The method ofclaim 7, further comprising designing, by the orthodontic server, aretaining device for the orthodontic patient at or near completion ofthe initial treatment plan.
 14. The method of claim 7, wherein the stepof designing and fabricating an orthodontic apparatus further comprisesreceiving, by the orthodontic server, design inputs from a diagnosticcomputer.
 15. A system for treating an orthodontic patient, the systemcomprising in combination: a scanner operable to obtain video data of anorthodontic structure of a patient; a site orthodontic system operablycoupled to the scanner, wherein the site orthodontic system receives thevideo data and produces therefrom a three-dimensional image of theorthodontic structure, wherein the site orthodontic system retains atwo-dimensional image of the orthodontic structure, and patient data,and wherein the three-dimensional image, the two-dimensional image, andthe patient data constitutes patient orthodontic information; anorthodontic server operably coupled to the site orthodontic system overa communication link to receive the patient orthodontic information andto produce therefrom an electronic patient record, wherein theorthodontic server generates an initial treatment plan for the patientbased on the electronic patient record and orthodontic parameters,wherein the initial treatment plan includes a plurality of toothmovement steps to obtain a desired orthodontic structure, and whereinthe orthodontic server designs an orthodontic apparatus in accordancewith one of the plurality of tooth movement steps; and a wire bendingdevice operably coupled to the orthodontic server to produce a wire ofthe orthodontic apparatus based on the design of the orthodonticapparatus, wherein the wire is designed to produce three-dimensionaldisplacement of at least one tooth of the orthodontic structure.
 16. Thesystem of claim 15, wherein the orthodontic server further comprises asoftware module for: determining whether an actual orthodontic structurefor the orthodontic apparatus substantially matches an estimatedorthodontic structure, wherein the estimated orthodontic structure isderived in accordance with the initial treatment plan; and when theactual orthodontic structure does not substantially match the estimatedorthodontic structure, adjusting the initial treatment plan to obtainthe desired orthodontics structure.
 17. The system of claim 15, whereinthe orthodontic apparatus further comprises at least one of: brackets, awire, head gear, rubber band placement, and a retaining structure. 18.The system of claim 15, wherein the scanner further comprises: a lightimaging transitive; and an image processing module operably coupled tothe light imaging transceiver to generate a topography of theorthodontic structure and to produce therefrom the video data.
 19. Thesystem of claim 15, further comprising: a database of orthodonticparameters operably coupled to the orthodontic server, wherein theorthodontic server: obtains special treatment information when specialtreatment is required; obtains orthodontic parameters for theorthodontic patient from a database of orthodontic parameters, whereinthe orthodontic parameters are identified by cross-matching at leastsome characteristics of the electronic patient record with orthodonticparameters of other electronic patient records; generates a first passtreatment plan based on the orthodontic parameters and the electronicpatient records; and integrates the special treatment information withthe first pass treatment plan to produce the initial treatment plan. 20.The system of claim 15, further comprising: a database of orthodonticparameters operably coupled to the orthodontic server, wherein theorthodontic server: obtains orthodontic parameters for the orthodonticpatient from a database of orthodontic parameters, wherein theorthodontic parameters are identified by cross-matching at least somecharacteristics of the electronic patient record with orthodonticparameters of other electronic patient records; and generates theinitial treatment plan based on the orthodontic parameters and theelectronic patient record.
 21. The system of claim 15, furthercomprising a diagnostic computer that provides design inputs to theorthodontic server.
 22. A system for treating an orthodontic patient,the system comprising in combination: at least one processing module;and memory operably coupled to the at least one processing module,wherein the memory stores operational instructions that cause the atleast one processing module to: create an electronic patient record fromdigital information regarding a patient's orthodontic structure;generate an initial treatment plan from the electronic patient record,wherein the initial treatment plan includes a plurality of toothmovement steps to obtain a desired orthodontic structure; and design anorthodontic apparatus for one of the plurality of tooth movement stepsupon receipt of a treatment plan confirmation.
 23. The system of claim22, wherein the memory further comprises operational instructions thatcause the at least one processing module to adjust the initial treatmentplan when an actual orthodontic structure does not substantially matchthe orthodontic structure estimated by the initial treatment plan. 24.The system of claim 22, wherein the memory further comprises operationalinstructions that cause the at least one processing module to: updatethe digital information after placement of an orthodontic apparatus,such as brackets, of the orthodontic structure after rescanning thepatient's orthodontic structure; and determine whether the placement ofthe brackets is within a given tolerance.
 25. The system of claim 22,wherein the memory further comprises operational instructions that causethe at least one processing module to: obtain special treatmentinformation when special treatment is required; obtain orthodonticparameters for the orthodontic patient from a database of orthodonticparameters, wherein the orthodontic parameters are identified bycross-matching at least some characteristics of the electronic patientrecord with orthodontic parameters of other electronic patient records;generate a first pass treatment plan based on the orthodontic parametersand the electronic patient record; and integrate the special treatmentinformation with the first pass treatment plan to produce the initialtreatment plan.
 26. The system of claim 22, wherein the memory furthercomprises operational instructions that cause the at least oneprocessing module to: obtain orthodontic parameters for the orthodonticpatient from a database of orthodontic parameters, wherein theorthodontic parameters are identified by cross-matching at least somecharacteristics of the electronic patient record with orthodonticparameters of other electronic patient records; and generate the initialtreatment plan based on the orthodontic parameters and the electronicpatient record.
 27. The system of claim 22, wherein the memory furthercomprises operational instructions that cause the at least oneprocessing module to, for each application of a corresponding apparatusof the initial treatment plan, generate a three-dimensional image of theorthodontic patient's current orthodontic structure; and store thethree-dimensional image.
 28. The system of claim 22, wherein the memoryfurther comprises operational instructions that cause the at least oneprocessing module to design a retaining device for the orthodonticpatient at least one of at and near completion of the initial treatmentplan.